Urinary Incontinence NICE Guidance

Urinary incontinence  Involuntary leakage of urine  Common condition  Affects women of different ages  Physical/psychological/social impact

Types of incontinence  Stress  Urge  Mixed  Overactive bladder

Initial Assessment  Bladder diary  Urinalysis  Post-void residual urine

Lifestyle changes  Modify fluid intake  Lose weight  Reduce caffeine

Stress incontinence  Pelvic floor exercises  Duloxetine

Stress incontinence  Retropubic mid-urethral tape  Intramural bulking agents  Colposuspension  Artificial urinary sphincter

Urge incontinence/OAB  Bladder training  Antimuscarinic drugs  Intravaginal oestrogens  Desmopressin

Urge incontinence/OAB  Botulinum toxin A  Sacral nerve stimulation  Augmentation cystoplasty

Urgent referral  Microscopic haematuria >50  Macroscopic haematuria  Recurrent/persisting UTI with haematuria >40  Suspected pelvic mass arising from urinary tract

Routine referral  Symptomatic prolapse seen at or below introitus  Palpable bladder after voiding

Consider referral  Persisting bladder or urethral pain  Clinically benign pelvic masses  Associated faecal incontinence  Suspected neurological disease  Voiding difficulty  Suspected urogenital fistula  Previous continence surgery  Previous pelvic surgery or radiation

Catheterisation  Persistent urinary retention causing incontinence, symptomatic infections, renal dysfunction  Urine contamination of wounds, pressure sores  Distress/disruption caused by bed/clothing changes  Patient preference

 A anticholinergic  B blood tests  C desmopressin  D HRT  E Intermittent catheterisation  F long term Abx  G MSU  H PFE  I prolapse  J reassurance  K refer  L sibutramine  M USS  N weight loss Incontinent woman AbnormalNormal Treat Resolved? Incontinence persists Predominantly stress Predominantly urge No better

Answers  1 G  2 N  3 J  4 H  5 A  6 K